Imaging characteristics and clinical management of intraosseous hemangioma in tubular bones: a retrospective case series

OBJECTIVES: Intraosseous hemangioma (IH) is a rare benign vascular tumor of bone, infrequently observed in tubular bones. The imaging characteristics of IH in these locations remain poorly defined. This study aimed to characterize the imaging features and clinical management of IH in tubular bones. METHODS: This retrospective analysis reviewed the imaging and clinical data of 10 patients with histopathologically confirmed IH of tubular bones. RESULTS: Of the 10 patients, seven were female (70%) and three were male (30%), with ages ranging from 10 to 75 years (mean ± SD, 40.1 ± 22.8 years). Nine patients (90%) presented with localized pain and swelling. Radiographic findings included six purely osteolytic lesions (60%), three with a soap-bubble appearance (30%), and one lesion (10%) was heavily calcified with a lobulated morphology. Among intramedullary cases, three showed cortical destruction, two had pathological fractures. Two lesions (20%) were confined to the cortex, demonstrated cortical thickening, sclerosis, and internal lytic changes. MRI revealed iso- or hypointense on T1WI and hyperintense on T2WI/STIR in three patients (30%). One patient (10%) displayed patchy hyperintensity on both T1WI and T2WI, with partial hypointensity on T2-STIR. Flow voids corresponding to low-signal blood vessels were seen in four patients (40%), while one (10%) exhibited a hypervascular lesion. Among the four patients who underwent contrast-enhanced CT or MRI, all marked heterogeneous enhancement. Nine patients (90%) were treated with curettage of the lesion, while one patient (10%) underwent complete lesion excision. In one hypervascular case, preoperative DSA embolization was performed. CONCLUSION: Intraosseous hemangioma of tubular bones predominantly present as osteolytic lesions with characteristic soap-bubble morphology on radiographs. Recognition of intralesional vascular structures is critical for diagnosis. Imaging modalities, particularly CT and MRI, enable precise lesion characterization and assist in surgical planning. In hypervascular cases, preoperative embolization guided by vascular imaging can effectively minimize intraoperative bleeding risk.